View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 3206-0167	ICR Reference No: 201803-3206-008
Status: Historical Active	Previous ICR Reference No: 201502-3206-005
Agency/Subagency: OPM	Agency Tracking No: RI 34-1, 34-3, 34-17, 34-18, 34-19, 34-20
Title: RI 34-1, 34-17, Financial Resources Questionnaire, RI 34-3, RI 34-19, Notice of Amount Due Because of Annuity Overpayment and RI 34-20, Notice of Amount Due Because of FEHB Premium Underpayment.
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/13/2018
	Date Received in OIRA: 06/28/2018
Terms of Clearance: OPM should consider if this collection of forms should be converted to a common form.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	36 Months From Approved	08/31/2018
Responses	2,361	0	2,081
Time Burden (Hours)	2,361	0	2,081
Cost Burden (Dollars)	0	0	0

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Notices of Amount Due Because of Annuity Overpayment	RI 34-3, RI 34-1, RI 34-17, RI 34-18, RI 34-20, RI 34-19, RI 34-1 , RI 34-3 , RI 34-17, RI 34-18, RI 34-19, RI 34-20	, , , , , , , , , , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	2,361	2,081	280
Annual Time Burden (Hours)	2,361	2,081	280
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is a change to the respondent burden, due to a program change. Forms RI 34-18 and RI 34-20 have been added.

Annual Cost to Federal Government: $126,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Charles Conyers 202 606-0125 charles.conyers@opm.gov

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